External Measurement as a Catalyst for Change in a Regional Results-Based Aid Initiative - The Salud Mesoamerica Experience

Salud Mesoamerica Initiative (SMI) is an ambitious regional results-based aid initiative in Mesoamerica that ties a portion of donor funding to the achievement of externally measured maternal, newborn and child health results—at both the micro/service-delivery and macro/population levels—in the participating countries’ poorest municipalities. SMI relies exclusively on independent (external) teams to measure results which determine funding approval. In contrast, other results-based financing initiatives typically determine payment through self-reported results that are verified. Countries have benefited from this system because external measurement and SMI support have strengthened local capacity to collect and analyze data to monitor performance, identify bottlenecks and hold people accountable. The primary decision to rely on external measurement was primarily driven by the donors’ requirement that performance payments to participating countries must be based on results that were true, as well as the Inter-American Development Bank’s requirement to minimize fiduciary risk associated with administration of these donor funds. The secondary reason to rely on external measurement was the need for comparable data across all countries to monitor overall impact and contribute to global learning.